SASKATOON — The Student Medical Society of Saskatchewan (SMSS) Government Affairs & Advocacy Committee recently presented a panel discussion on physician-assisted death at the University of Saskatchewan.
The panel included Dr. Cindy Forbes, Canadian Medical Association (CMA) president; Bryan Salte, legal counsel, Royal College of Physicians & Surgens of Saskatchewan (CPSS); and Dr. Ketih Ogle, College of Family Physicians of Canada (CFPC) Task Force on End-of-Life Care. The March 15 event attracted a crowd of some 200, with a group also participating by video conference from the University of Regina.
The panel was convened to discuss the implications of the Supreme Court of Canada’s Carter decisions, which stuck down Canada’s laws against physician-assisted death. It is unclear whether the government will legislate to include both euthanasia and physician-assisted suicide under physician-assisted death, or if it will legalize only one of these practices.
Moderators from the SMSS posed questions to the panel for an hour, followed by a half-hour period in which written questions from the audience were posed. The first questions centred on practical considerations for physicians.
Panel members focused on a physician’s ability to assess a patient’s competency to give consent to physician-assisted death. While Forbes stated that physicians routinely assess consent, Ogle stated that most physician-assisted death guidelines require two physicians because these practices are different from most medical decisions. Salte echoed this, saying that patients experience many pressures at the end of life, including pressure from families, which makes them particularly vulnerable and increases the need to verify that consent is autonomous.
Panel members also discussed whether euthanasia and assisted suicide should only be performed by physicians, or if other health care professionals should be part of the decision-making process. They generally agreed that the model of care in Canadian health care is team-based, which would mean that physicians would likely consult with other health care professionals regarding a patient’s decisions.
However, Salte pointed out that patients with different life expectancies will likely be treated differently. “This is intended to alleviate suffering. (I would) hate to see people remain in suffering due to lengthy checks,” he said.
The panel also discussed extending physician-assisted death to persons with a psychiatric illness, children, and persons who have given prior consent through advance care directives. Much of the discussion focused more generally on whether or not advanced care directives are an effective means of communicating a patient’s medical decisions once the patient has lost the capacity to make their own. Salte suggested persons could consent to physician-assisted death through a special advance care directive that is supervised by someone who can confirm the competency of the patient. This is in contrast to current advance care directives that do not require such a witness.
Regarding physician-assisted death for children, Ogle referenced National Post columnist Andrew Coyne’s comment that contemplating euthanasia for children is “indicative of a society that’s lost its way.” He said, “for the protection of children its reasonable to sacrifice some of their presumed rights.”
The topic prompted Forbes to say, “I didn’t enter medical school thinking I would be helping people die.” She encouraged caution in expanding access to physician-assisted death to different groups.
The topic of mandatory referral for physicians was also addressed by the panel, who expressed a hope that the government would provide a centralized agency to address requests for physician-assisted death. They also said that government-funded faith-based institutions would likely be required to provide physician-assisted death. However, these comments were tempered by an acknowledgement from Salte that there is “a great deal of uncertainty” around legislation in these areas.
The panel also focused on the need to develop palliative care to ensure that patients are making a true choice regarding their options at the end of life. They ended the discussion saying that it was impossible to guess the future.